From Mr G. S. Phillips, MRPharmS
SIR,—While I am grateful for her response, I really cannot allow Mrs Remington (PJ, January 22, p131) to side-step the majority of the substantive points I raised in my letter. On the one hand, she is insistent upon technician training and registration, and, upon the other, states: "Certainly, Mr Phillips has assessed the capabilities of his medicines counter assistant and applied them in a discretionary way." May I remind her that the Society's paper on the subject (PJ, March 13, 1999, p351) stated that anyone involved in the assembly of a prescription must undertake (at a minimum) an NVQ level 2 training course. It is precisely the lack of discretion implied in that statement, and reiterated in her letter, that is the point at issue. For the record - Yes! Of course I am in favour of training!
Regarding resale price maintenance, Mrs Remington conveniently chooses to ignore my point that, should RPM be lost, fewer people will purchase medicines for self-treatment from a pharmacy, and will thus be denied pharmaceutical care. She states that it is the business of others to put forward the financial interests of pharmacists. Why, then, did the Society produce a paper on potential remuneration structures for community pharmacy? Why, then, has the Society previously made it clear that it does have a role in discussing remuneration when it affects the distribution of pharmacies? Again, Mrs Remmington chooses to ignore the pivotal public interest argument: Is it in the public interest for the network of community pharmacies to collapse? This is the risk if RPM were to go.
Underlying all of this debate are fundamental issues of representation, leadership and morale. My experience talking to "rank-and-file" pharmacists from all sectors of the profession is that most feel disaffected with, and disenfranchised by, our professional body. Far too often the communication from Lambeth is negative and critical. All too seldom is there praise for our successes. We have just emerged from one of the most pressured periods the National Health Service has known. Despite talk of an NHS in crisis and near to collapse, community pharmacists have coped with the huge increase in seasonal demand, in the way we always do: calmly and professionally. And we should be proud of our contribution. Certainly we must move forward and yes, of course we must be prepared to change. It is folly, however, to ignore the need for resources to fund the professional and infrastructure developments which are required. Pronouncements from the ivory tower which ignore the logistical and financial realities we face will never win the hearts and minds of the pharmacists at the coal face who, ultimately, must deliver the new vision.
Finally, I would make this challenge to Mrs Remington. Since we are in agreement that the future must be based upon pharmaceutical care (not merely supply) she should come and spend some time in my pharmacy and view primary care from the sharp end. She should learn first-hand the difficulties we face and experience the contribution we make, both to the treatment of illness and to the promotion of health. Then, when she comments upon the future, it will be from a position of understanding and mutual respect.
Graham Phillips
Harpenden, Hertfordshire
Mrs REMINGTON replies: NVQ2 training is proposed for staff involved in the assembly of products in a dispensary. I support this.
The Society supports the extension in role of community pharmacists and the models for remuneration were a contribution to the culture change management required. It is evidence we are not ignoring the need for resources and their allocation to be changed.
The "Over to you" work is one opportunity the Society takes to promulgate the very valuable work pharmacists contribute to pharmaceutical care of patients.
I recognise the contribution community pharmacists make, and, indeed, the further potential, and express this regularly when talking about the future. We work in different environments finding different expressions for our professionalism. My respect is not in doubt. Spending time in Mr Phillips's pharmacy would be a pleasure I am sure, but I must rely on the colleagues I meet at branch meetings to keep me abreast of the issues he faces.